Huddles, Muddles and Ruddles: a new language at St Vincent’s

In each of the inpatient areas of our hospital, there is a new language emerging.  Visitors to these wards and departments may be exposed to, “WOWing,” “Error free, check at three,” “Charts in line at nine,” “Cake target,” “Direct care time,” as well as “Huddle” and its derivatives, “Muddle,” and “Ruddle.”

The Productive Ward is a licensed framework designed by the National Health Service in Britain that focusses on improving ward processes and environments to help health professionals spend more time with their patients.  To date, the Productive Ward has been rolled out to 24 inpatient areas across our hospital.

Below is a glossary that should help visitors understand some of the evolving Productive Ward language overheard on our inpatient wards:

Vision Statement: Collaborating on a Vision Statement is the first step in The Productive Ward.   Teams brainstorm, script, vote upon and design their team Vision, often with patient input.  Teams require a cohesive vision so that they all know why they are trying to improve – the vision should describe the ward or area at its absolute best.

 Knowing How We Are Doing Board:  These large boards containing up-to-date performance data are located in a central spot on each ward.  Where possible, they are accessible to staff, patients and visitors.  The Productive Ward promotes open discussion and transparency regarding the ward’s opportunities for problem-solving and improvement.

 Activity Follow and Direct Care Time:  One staff member follows another for an entire shift and takes note of the activity being performed each minute.  The information is entered into a spreadsheet and graphs are produced that detail how much time the clinician was able to spend with his or her patients, as well as information on what got in the way.

WOWing:  Within WOW or the Well Organised Ward module, team members work together to systematically ensure that all equipment and items on the ward are placed in the best location for efficiency and are ready for use at a moment’s notice.

Charts in line at 9:  Invented on Level 4, the phrase, “Charts in line at 9” can be heard at 9pm every day.  Nursing staff work together at this time every day to ensure that medication charts have been completed accurately.

Cake target:  If reaching a long-term goal seems to be slow going, teams are often buoyed by a closer target.  The incentive to reach the goal is trebled if it comes with the promise of cake!

Error free, check at 3:  Currently in use at Rehab, Kew, the staff get together to check med charts daily at 3pm.

 Huddle:  Interdisciplinary teams hold a “stand-up” meeting for 15 minutes per week in front of their Knowing How We Are Doing boards, in order to discuss any new opportunity for improvement.  These discussions focus upon data rather than anecdotes and encourage problem-solving as a team.

 Muddle:  7 East’s creation!  A mid-shift huddle where nursing staff meet for 5 minutes daily to proactively balance workloads and mitigate risk.

 Ruddle:  9 East’s creation!  What do you get when Russell runs a Huddle?  A Ruddle!  What’s more, it’s an acrostic: “Really Uplifting Discussions Directly Linking Everyone.”

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9 East

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